Alterations in Respiratory Function

Objectives

List the clinical manifestations of common alterations in respiratory function Outline the critical care management of patients with alterations in respiratory function

Common Alterations in Respiratory Function
Acute Obstructive Airways Diseases

Pulmonary Oedema

Case

 

75yo ♀ BIBA w/ 1/52 HO ↑ SOB Sp02 86% on RA  98% on HM @ 6LPM. HR 155, BP 105/55, peripherally cool. T: 38.6 GCS 14 (E: 4 V: 4 M:6)

Assessment Physical Assessment  ↓ R) chest wall expansion  Tactile fermatas  ↓ AE R) lower lobe Blood work-up  ↑ WCC CXR ECG .

Case .

Case .

Management     O2 therapy Circulatory support IVABs Monitor .

Lower Respiratory Tract Infection  Pneumonia    Bacterial Viral Aspiration  Tuberculosis .

Pulmonary Oedema  Alteration in hydrostatic and/or osmotic pressure .

Traumatic Injury  Rib #s .

Traumatic Injury   Rib #s Pleural Effusion .

Traumatic Injury    Rib #s Pleural Effusion Pneumothorax  Tension pneumothorax  Heamothorax .

Traumatic Injury .

Chest Drains .

Chest Drains .

Chest Drains .

Chest Drains .

Chest Drains .

Chest Drains .

Chest Drains .

Chest Drains .

Chest Drains .

Chest Drains .

Neurological Disease     Spinal cord disease Motor nerve disease Infectious disease Muscle-wasting disease .

Acute Obstructive Pulmonary Disease  Acute Bronchitis .

Acute Obstructive Pulmonary Disease   Acute Bronchitis Asthma .

Chronic Obstructive Pulmonary Disease  Bronchiectasis .

Chronic Obstructive Pulmonary Disease    Bronchiectasis Cystic Fibrosis Chronic Bronchitis .

Chronic Obstructive Pulmonary Disease     Bronchiectasis Cystic Fibrosis Chronic Bronchitis Pulmonary Emphysema .

Industrial Illness    Organo-phosphate poisoning Asbestosis Coal workers’ pneumoconiosis .

Adult Respiratory Distress Syndrome “The acute onset of severe respiratory distress and cyanosis that was refractory to oxygen therapy and associated with diffuse CXR abnormality and decreased lung compliance”. .

Adult Respiratory Distress Syndrome    Severe hypoxemia Loss of lung compliance Secondary disease     Reduced perfusion Increased capillary permeability Direct tissue and capillary insult Other mechanism  Despite primary disease. same pathology exists .

Adult Respiratory Distress Syndrome Signs and Symptoms           Tachypnoea Cyanosis Diaphoresis Tachycardia Hyperventilation Scattered crackles Increased work of breathing Agitation Lethargy Decreased LOC .

Adult Respiratory Distress Syndrome Signs and Symptoms  Acute onset (usually within 4 hours or 2-4 days of initial trauma)  Bilateral Infiltrates  Two Categories:   PaO2/Fio2 ratio < 300 (ALI) PaO2/Fio2 ratio < 200 (ARDS) (ALI is milder than ARDS that may or may not progress onto ARDS) .

Adult Respiratory Distress Syndrome Treatment  ABC  Mechanical ventilation  Monitor  Treatment of underlying disease  Medications  Prone Positioning (189±34 v 83±14)  Nutritional Support .

Oxygen Therapy  Nasal Prongs   Low flow 2 – 4 LPM .

Oxygen Therapy  Hudson Mask    Variable flow 6 – 15 LPM ~40–60% .

Oxygen Therapy  Non-Rebreather Mask    High flow Inflate bag ~90-95% .

Oxygen Therapy  Venturi Mask   High flow Adjust oxygen to flow rate .

Oxygen Therapy  Bag mask ventilation    High flow 100% Respiratory support .

Alterations in Respiratory Function .

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